Posterior Tibial Tendon Dysfunction (PTTD)

What Is PTTD?
The TIb Post serves as major supporting structure of the foot, helping it to function through gait. Posterior
tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its
ability to support the arch. This results in flattening of the foot.

PTTD often called “adult acquired flatfoot” because it is the most common type of flatfoot developed
during adulthood. PTTD is progressive, which means it will keep getting worse, especially if it isn’t
treated early. May involve Tenosynovitis with fluid and synovial thickening around the tendon causing
increase in symptoms.

Origin: Deep posterior compartment: Interoseous membrane. Main insertions: Navicular and Med
Cuneiform

Risk Factors
 Diabetes; Reduced or poor blood diffusion to tendon increased
 Hypertension: Blood supply issues
 Previous foot/ankle surgery or trauma
 Inflammatory disease RA, Psoriasis, Spondylsin Arthrophay:
 Local steroid injections; Atrophy of tendon

Causes
Overuse. Obesity. Age-related changes; as people age tendons lose elasticity and ability to glide as smoothly as they used to. Accessory Navicular
Sesamoid (Bone) When present, it lies in front of the area where the PTT would normally attach to Navicular, may prevent tendon from pulling on the true
Navicular and maintaining the arch height and normal foot position

Symptoms
Pain following path of tendon, swelling most common around medial malleoli, flattening of the arch, and an inward rolling of the ankle everted calcaneus. As
symptom progress deformity increases

Classification
S1: Synovitis no deformity, S2: Flexible deformity +/- Rupture, S3: Severe degeneration +/-Rupture, rigid deformity

Tests:
Equinus contracture: Poor dorsiflexion causes Tib Post to accept additional load during gait
“too many toes sign”: With damage to the posterior tibial tendon, the forefoot will abduct or move out in relationship to the rest of the foot
Single limb heel raise: Inability to contract TP properly without pain

Non-surgical Treatment
PTTD is a mechanical problem that requires a mechanical solution If treated early enough, your symptoms may resolve without
the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an
extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

 Orthotic devices or bracing. give arch the support it needs, an ankle brace or a custom orthotic device that fits
into the shoe.
 Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal,
or you may need to completely avoid all weight-bearing for a while.
 Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
 Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
 Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed
to improve arch support.
 Trilok brace: Acts similar to Tib post or J strapping in that its function mimics the muscles supinator motion

When Is Surgery Needed?

Medial Displacement Calcaneal Osteotomy: Takes wedge of lateral calc and moves it medially causing a Varus heel and straighten Achilles.
Triple Arthrodesis: gold standard in oldies: Fuses main cause of deformity talus, Calc and Navicular